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{{Constipation}}
{{Constipation}}


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==Overview==
A positive history of straining, hard [[stools]], sensation of incomplete evacuation, sensation of [[anorectal]] [[obstruction]], manual maneuvers, and less than 3 [[Defecation|defecations]] weekly is suggestive of constipation. The most common symptoms of constipation include infrequent [[Bowel movement|bowel movements]], [[Bloating|abdominal bloating]], necessity to strain, and [[anal pain]]. Less common symptoms of constipation include [[Fullness after a meal|fullness]], visible [[abdominal distention]], incomplete evacuation, [[abdominal pain]], [[rectal bleeding]], and [[mass]] protrusion.
==History and Symptoms==
*The hallmark of constipation is decreased number of [[Bowel movement|bowel movements]] and hardened [[stool]]. A positive history of straining, hard [[stools]], sensation of incomplete evacuation, sensation of [[anorectal]] [[obstruction]], manual maneuvers, and less than 3 [[Defecation|defecations]] weekly is suggestive of constipation. The most common [[symptoms]] of constipation include infrequent [[Bowel movement|bowel movements]], [[Bloating|abdominal bloating]], necessity to strain, and [[anal pain]].
===History===
Patients with constipation may have a positive history of:<ref name="Rao2008">{{cite journal|last1=Rao|first1=Satish S. C.|title=Approach to the Patient with Constipation|year=2008|pages=373–398|doi=10.1002/9781444300758.ch20}}</ref>
*Straining
*Lumpy or hard [[stools]]
*Sensation of incomplete evacuation
*Sensation of [[anorectal]] [[obstruction]] or blockage
*Digital maneuvers
*Less than 3 [[Defecation|defecations]] per week
The important factors in the history of patients with constipation include:<ref name="pmid21382584">{{cite journal| author=Rao SS, Meduri K| title=What is necessary to diagnose constipation? | journal=Best Pract Res Clin Gastroenterol | year= 2011 | volume= 25 | issue= 1 | pages= 127-40 | pmid=21382584 | doi=10.1016/j.bpg.2010.11.001 | pmc=3063397 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21382584  }}</ref>
* [[Bowel]] habits description
* Onset of [[symptoms]]
* Duration of [[symptoms]]
* Severity of [[symptoms]]
* Precipitating events
* [[Laxative]] use: Type, number, and frequency
* Dietary history: Fiber and fluid intake
* [[Family history]]: [[Bowel]] function


==Overview==
===Common Symptoms===
When the stool is hard, infrequent, and requires significant effort to pass, you have constipation. The passage of large, wide stools may tear the mucosal membrane of the anus, especially in children. This can cause bleeding and the possibility of an anal fissure.
Common [[symptoms]] of constipation include:<ref name="pmid9269805">{{cite journal |vauthors=Koch A, Voderholzer WA, Klauser AG, Müller-Lissner S |title=Symptoms in chronic constipation |journal=Dis. Colon Rectum |volume=40 |issue=8 |pages=902–6 |year=1997 |pmid=9269805 |doi= |url=}}</ref>
*Infrequent [[Bowel movement|bowel movements]]
*[[Bloating|Abdominal bloating]]
*Necessity to strain
*[[Anal pain]]


==Diagnostic Criteria==
==== Bristol Stool Form Scale ====
The diagnostic criteria based on the American Gastroenterological Association (AGA),<ref name="pmid23261065">{{cite journal| author=Bharucha AE, Pemberton JH, Locke GR| title=American Gastroenterological Association technical review on constipation. | journal=Gastroenterology | year= 2013 | volume= 144 | issue= 1 | pages= 218-38 | pmid=23261065 | doi=10.1053/j.gastro.2012.10.028 | pmc=PMC3531555 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23261065  }} </ref> Rome III criteria<ref name="Longstreth-2006">{{Cite journal | last1 = Longstreth | first1 = GF. | last2 = Thompson | first2 = WG. | last3 = Chey | first3 = WD. | last4 = Houghton | first4 = LA. | last5 = Mearin | first5 = F. | last6 = Spiller | first6 = RC. | title = Functional bowel disorders. | journal = Gastroenterology | volume = 130 | issue = 5 | pages = 1480-91 | month = Apr | year = 2006 | doi = 10.1053/j.gastro.2005.11.061 | PMID = 16678561 }}</ref> and pharmacologic studies based criteria<ref name="Lembo-2010">{{Cite journal | last1 = Lembo | first1 = AJ. | last2 = Kurtz | first2 = CB. | last3 = Macdougall | first3 = JE. | last4 = Lavins | first4 = BJ. | last5 = Currie | first5 = MG. | last6 = Fitch | first6 = DA. | last7 = Jeglinski | first7 = BI. | last8 = Johnston | first8 = JM. | title = Efficacy of linaclotide for patients with chronic constipation. | journal = Gastroenterology | volume = 138 | issue = 3 | pages = 886-95.e1 | month = Mar | year = 2010 | doi = 10.1053/j.gastro.2009.12.050 | PMID = 20045700 }}</ref> is as follows.
* The [[Bristol Stool Scale|Bristol Stool Form Scale]] is a tool to investigate the [[stool]] form and it helps to identify the colonic transit time.
* Very hard [[stools]] may reflect the highest and watery [[stools]] may reflect the lowest colonic transit time.<ref name="pmid7930429">{{cite journal |vauthors=Heaton KW, O'Donnell LJ |title=An office guide to whole-gut transit time. Patients' recollection of their stool form |journal=J. Clin. Gastroenterol. |volume=19 |issue=1 |pages=28–30 |year=1994 |pmid=7930429 |doi= |url=}}</ref>


{|class="wikitable"
==== Patient Assessment Constipation-Quality of Life (PAC-QOL) ====
! Rome III criteria<ref name="pmid23261065">{{cite journal| author=Bharucha AE, Pemberton JH, Locke GR| title=American Gastroenterological Association technical review on constipation. | journal=Gastroenterology | year= 2013 | volume= 144 | issue= 1 | pages= 218-38 | pmid=23261065 | doi=10.1053/j.gastro.2012.10.028 | pmc=PMC3531555 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23261065  }} </ref><ref name="Longstreth-2006">{{Cite journal  | last1 = Longstreth | first1 = GF. | last2 = Thompson | first2 = WG. | last3 = Chey | first3 = WD. | last4 = Houghton | first4 = LA. | last5 = Mearin | first5 = F. | last6 = Spiller | first6 = RC. | title = Functional bowel disorders. | journal = Gastroenterology | volume = 130 | issue = 5 | pages = 1480-91 | month = Apr | year = 2006 | doi = 10.1053/j.gastro.2005.11.061 | PMID = 16678561 }}</ref>!! Pharmacologic studies based criteria<ref name="pmid23261065">{{cite journal| author=Bharucha AE, Pemberton JH, Locke GR| title=American Gastroenterological Association technical review on constipation. | journal=Gastroenterology | year= 2013 | volume= 144 | issue= 1 | pages= 218-38 | pmid=23261065 | doi=10.1053/j.gastro.2012.10.028 | pmc=PMC3531555 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23261065  }} </ref><ref name="Lembo-2010">{{Cite journal  | last1 = Lembo | first1 = AJ. | last2 = Kurtz | first2 = CB. | last3 = Macdougall | first3 = JE. | last4 = Lavins | first4 = BJ. | last5 = Currie | first5 = MG. | last6 = Fitch | first6 = DA. | last7 = Jeglinski | first7 = BI. | last8 = Johnston | first8 = JM. | title = Efficacy of linaclotide for patients with chronic constipation. | journal = Gastroenterology | volume = 138 | issue = 3 | pages = 886-95.e1 | month = Mar | year = 2010 | doi = 10.1053/j.gastro.2009.12.050 | PMID = 20045700 }}</ref>
* Patient Assessment Constipation-Quality of Life (PAC-QOL) is a questionnaire to evaluate the [[quality of life]] of patients with constipation.
|-
* PAC-QOL is completely based on the common symptoms of the patients with constipation.<ref name="pmid16036506">{{cite journal |vauthors=Marquis P, De La Loge C, Dubois D, McDermott A, Chassany O |title=Development and validation of the Patient Assessment of Constipation Quality of Life questionnaire |journal=Scand. J. Gastroenterol. |volume=40 |issue=5 |pages=540–51 |year=2005 |pmid=16036506 |doi=10.1080/00365520510012208 |url=}}</ref>
| Symptom onset for ≥6 months and ≥2 of the following for the past 3 months:
● Straining during at least one-fourth of defecation<br>
● Hard or lumpy stools in at least one-fourth of defecation<br>
● Sensation of incomplete evacuation for at least one-fourth of defecation<br>
● Sensation of anorectal obstruction/blockade for at least one-fourth of defecation<br>
● Manual maneuvers to facilitate at least one-fourth of defecation<br>
● <3 defecations/week<br>
● Without the use of laxatives, loose stools are rarely present<br>
● No sufficient criteria for irritable bowel syndrome
|| Spontaneous bowel movements <3 per week and ≥1 of the following for at least 12 weeks during the past 12 months:
● Straining during more than one-fourth of defecation<br>
● Lumpy or hard stools in more than one-fourth of defecation<br>
● Sensation of incomplete evacuation in more than one-fourth of defecation<br>
● Absence of loose stools or watery spontaneous bowel movements
|-
|}


===Less Common Symptoms===
Less common symptoms of constipation include:<ref name="MertzNaliboff1999">{{cite journal|last1=Mertz|first1=H.|last2=Naliboff|first2=B.|last3=Mayer|first3=E. A.|title=Symptoms and physiology in severe chronic constipation|journal=The American Journal of Gastroenterology|volume=94|issue=1|year=1999|pages=131–138|issn=0002-9270|doi=10.1111/j.1572-0241.1999.00783.x}}</ref>
*[[Fullness after a meal|Fullness]]
*Visible [[abdominal distention]]
*Incomplete evacuation
*[[Abdominal pain]]
*[[Rectal bleeding]]
*Mass protrusion
*[[Dry skin]]
*[[Dysphagia]]
*[[Polyuria]]
*[[Polyphagia]]
*[[Polydipsia]]
*[[Tremor]]
*[[Gait abnormality|Gait imbalance]]
*[[Involuntary jerky movements|Involuntary movements]]
*[[Weight loss]]
*[[Weakness]]
==References==
==References==
{{Reflist|2}}
{{Reflist|2}}

Revision as of 18:22, 13 December 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Eiman Ghaffarpasand, M.D. [2]

Overview

A positive history of straining, hard stools, sensation of incomplete evacuation, sensation of anorectal obstruction, manual maneuvers, and less than 3 defecations weekly is suggestive of constipation. The most common symptoms of constipation include infrequent bowel movements, abdominal bloating, necessity to strain, and anal pain. Less common symptoms of constipation include fullness, visible abdominal distention, incomplete evacuation, abdominal pain, rectal bleeding, and mass protrusion.

History and Symptoms

History

Patients with constipation may have a positive history of:[1]

The important factors in the history of patients with constipation include:[2]

Common Symptoms

Common symptoms of constipation include:[3]

Bristol Stool Form Scale

  • The Bristol Stool Form Scale is a tool to investigate the stool form and it helps to identify the colonic transit time.
  • Very hard stools may reflect the highest and watery stools may reflect the lowest colonic transit time.[4]

Patient Assessment Constipation-Quality of Life (PAC-QOL)

  • Patient Assessment Constipation-Quality of Life (PAC-QOL) is a questionnaire to evaluate the quality of life of patients with constipation.
  • PAC-QOL is completely based on the common symptoms of the patients with constipation.[5]

Less Common Symptoms

Less common symptoms of constipation include:[6]

References

  1. ↑ Rao, Satish S. C. (2008). "Approach to the Patient with Constipation": 373–398. doi:10.1002/9781444300758.ch20.
  2. ↑ Rao SS, Meduri K (2011). "What is necessary to diagnose constipation?". Best Pract Res Clin Gastroenterol. 25 (1): 127–40. doi:10.1016/j.bpg.2010.11.001. PMC 3063397. PMID 21382584.
  3. ↑ Koch A, Voderholzer WA, Klauser AG, Müller-Lissner S (1997). "Symptoms in chronic constipation". Dis. Colon Rectum. 40 (8): 902–6. PMID 9269805.
  4. ↑ Heaton KW, O'Donnell LJ (1994). "An office guide to whole-gut transit time. Patients' recollection of their stool form". J. Clin. Gastroenterol. 19 (1): 28–30. PMID 7930429.
  5. ↑ Marquis P, De La Loge C, Dubois D, McDermott A, Chassany O (2005). "Development and validation of the Patient Assessment of Constipation Quality of Life questionnaire". Scand. J. Gastroenterol. 40 (5): 540–51. doi:10.1080/00365520510012208. PMID 16036506.
  6. ↑ Mertz, H.; Naliboff, B.; Mayer, E. A. (1999). "Symptoms and physiology in severe chronic constipation". The American Journal of Gastroenterology. 94 (1): 131–138. doi:10.1111/j.1572-0241.1999.00783.x. ISSN 0002-9270.

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